Ep. 060 | Building Community Strength In Recovery

Today, we chat with Sarah Sacala about how the community music therapy model can support the recovery process for substance use disorders. Please note that this episode includes content about drug use, systematic oppression from the American healthcare system, and stigma regarding substance use.

Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. We’re back for 4 episodes. My name is Erica Lee, and today, we chat with Sarah Sacala about how the community music therapy model can support the recovery process for substance use disorders. Please note that this episode includes content about drug use, systematic oppression from the American healthcare system, and stigma regarding substance use.

Sarah is a masters candidate in Clinical Mental Health Counseling with a specialization in Music Therapy from Lesley University. She earned a bachelors degree in vocal performance with a minor in psychology from Western Connecticut State University. Sarah’s clinical experience includes adults with substance use disorders within in-patient psychiatric settings. Currently,  Sarah also owns a teaching studio for piano, voice, guitar, and ukulele. 

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Erica: Welcome, Sarah, to the podcast. Thanks so much for being here.

Sarah: Happy to be here.

Erica: So we just wanna start with the question we ask everybody when we start the podcast is: how did you originally become interested in music therapy?

Sarah: Awesome, yeah. I mean, I think everyone has an amazingly unique story. I was in my undergrad for something completely different, and during my freshman year there, my father actually had a stroke. And when we were in the hospital he wasn’t responding to anything. But then we played a song, and he started responding – moving his body, which they said he couldn’t move, humming, and um verbalizing things with us. And I just kinda was like there’s gotta be a career for this! So [chuckles] just started the research. And that’s how I found it.

Erica: That’s awesome. So I had the honor of reading the thesis that you wrote for your program – it was very good.

Sarah: [Chuckles] Awesome.

Erica: [Laughs] And – so I will include the citation for the thesis in our episode notes, so if listeners want to go and read the whole thesis, you can find it there. But I just wanna give kinda some um foundational knowledge as we’re talking so that listeners can follow along with us. Um, what we’re talking about is substance use disorders, and using community music therapy as building social connections and networks to support the recovery process. And I’m curious, Sarah, how do you define what a substance use disorder is? And then, also within that question, is what harms are possible if we’re using definitions solely from the DSM?

Sarah: You know, the DSM does describe substance use disorders as a change in brain circuits – but from continuously using substances of many kinds: alcohol, certain kinds of drugs, sedatives – all that good stuff. Um, but mainly focuses on the symptoms of cognitive, behavioral, physiological – and it’s really based on patterns in life related to the disorder. For me, I’ve noticed it’s really that big criteria of social impairment – displeasure in activity, um really withdrawing from social life – that’s kind of the big piece of that definition I chose to focus on.

And I think the big issue with DSM diagnoses is they all are kind of seen as an umbrella construct. I think there’s just a lot of considerations that need to be made that aren’t listed in that book. Um, there’s cultural background, socioeconomic status, home life, trauma. Actually, funny back story: when I started researching this, I had said zero things about trauma in the paper – nothing.

Erica: Mmm.

Sarah: And I was like, I didn’t even think of it. But the DSM kinda doesn’t really put that in our brain. So I think those are, you know, the – the considerations that need to be taken into place when making a diagnosis, but the DSM doesn’t uh prioritize that concern.

Erica: Yeah. And I think, when it doesn’t acknowledge those contexts, you’re really then not acknowledging the fullness of a person.

Sarah: Mmhmm.

Erica: Because nobody comes in with just this really clinical kinda sterile, here are the behaviors you’re exhibiting, therefore you have this diagnosis.

Sarah: One hundred percent – one hundred percent, I agree.

Erica: Yeah. Um, you said uh social impairment. What does that mean?

Sarah: Yeah, so um social impairment is just really involves the impairment of school, work, home life – withdrawing from recreational activity, family activity. Um, you hear it a lot with depression, that you’re gonna withdraw from things that used to bring you pleasure. It’s kind of the same idea. Which – which makes sense because substance use is really comorbid/co-working with other diagnoses.

Erica: Mmm, yeah. You talked a lot in your paper about stigma and then how bias plays into the recovery process —

Sarah: Mmhmm.

Erica: I’m curious – can you share more about how stigma and unconscious bias regarding substance use impacts recovery for people?

Sarah: Yeah, of course. I mean, it was one of those things where I knew it was there, and I knew  it existed, I just didn’t know the extent. And that’s another reason I chose to research a focus on stigma and advocacy and all that. Because um – it was really interesting to find out how even just portraying people with substance use disorders as a certain way in news articles, in police reports, in things like that – it was a sign to other people suffering saying, ugh I can’t go get help. There’s this shame/there’s this guilt attached to it, which is a barrier to that recovery process. Um, and even – less of stigma but financially – it’s really tough to find recovery. And I think there’s stigma attached to people who don’t go to recovery.

But it’s not as clean cut as we think. It’s not easy to find a bed in a hospital. It’s not easy to uh finda, you know, an insurance plan that covers your treatment. It’s not easy to pay that all out of pocket. Um, what if you need crisis care and you can’t afford that? There’s a lot of points that are -are really much harder than meets the eye, and people just see it as oh, you don’t wanna change.

I think stigma is not – not the issue of the person going through it. They know what they’re going through. I think people don’t give um those suffering with this disorder enough credit. I can 100% say that they have taught me so much. Like, here’s how it works in my brain, and I’m like oh! Oh, okay, you’re giving me a neurobiology [chuckles] —

[Erica laughs]

Sarah: A neurobiology, you know, quiz now. But really, it’s like – they know what’s happening, and I think stigma it’s not they’re responsibility. It’s really not. It’s really the responsibility of you, me, of everyone else out there.

Erica: Yeah. No, I – I so agree with you. I think…yeah… That’s gonna stay with me for the rest – rest of today at least. And it really highlights the way that our healthcare system is set up and the ways that just systematic oppression is so real. It impacts people’s ability to – even if they want help – to actually get the help.

Sarah: Exactly. And there are plenty of healthcare professionals out there who have not tapped into addressing their unconscious biases, and that 100% effects recovery process. You need a supportive treatment team. You need a supportive support system – family, community, um whatever community looks like to that person. Um, and I think that’s another important to note – that community looks really different for everyone.

Erica: Yeah. Um, you talked about the importance of support systems for people in recovery. Why is social connection so important to the recovery process?

Sarah: Mmhmm. Uh, I think it was something that people can maybe assume but don’t know the real damage of it until maybe you’re talking with someone suffering with the disorder. But the people who struggle most in recovery are the ones facing stigma or rejection from their society – from their community, and if they don’t have a social network, or support from the community, they – they may never even seek that recovery.

Erica: Mmm.

Sarah: A lot of people – I think it’s fair to say a lot of us, you know, like, our friends/our family backing us up on things. I think this is the same thing and people just don’t think of it as the same thing.

You know, in that DSM diagnosis, social impairment is one of those criteria. And – and when you’re withdrawing, you’re not seeking that help. And if there’s no social connection, there’s no inclusion – which means people can’t define their own recovery, and they can’t – they can’t recruit that community strength or help.

Erica: Mmm. Oh, that community strength – that’s such a good—

Sarah: Mmhmm—

Erica: Phrase. I love that. So, in thinking about how music therapy – specifically community music therapy – can support building these relationships and connections, can you tell us: what is your definition—

Sarah: Yeah—

Erica: Of community music therapy? So, what does that mean for you? And then could you give us a couple examples of what that might look like?

Sarah: Yeah. I mean, personally, I think my definition has changed a lot since doing the research.

Erica: Oh!

Sarah: At first I was like, community music therapy is we all come together and we’re happy and singing. But that was kind of where I had to start with this one. But, you know, on my journey of researching this topic and this practice, I’ve really come to find it’s promoting health – within layers of sociocultural community and um physical environment.  And I think it’s a practice very focused on the change in social agenda, and activism, and social justice. But it’s more than let’s get together and sing Kumbaya, right [chuckles].

Erica: Yeah.

Sarah: It’s – it’s um we need to come together do this work so that the world can be more helpful to everyone else, and more kind to people suffering from mental illness. This needs to be an agenda for social change.

Erica: I love that. SO what does that look like? Or, in your clinical experiences thus far, what has that looked like?

Sarah: Yeah. Um, it’s a group that comes together to foster participation – with the tool of social change together. So, like we said, social impairment’s a really main criteria for substance use disorders, and I think having that supportive community and – and being able to share thoughts is really big with that. Um, so I have found like lyric substitutions are really powerful – like group lyric substitutions or one-on-one and then sharing with the group.

And what that kinda looks like, for people who don’t know, is: you take a song that already exists, and what you do is – as a therapist – you take out certain phrases of that song where it makes sense – where the client can fill in what they’re feeling. So, you’re taking a very similar story that this artist of this song maybe was going through – that you could maybe assume they were going through while writing it – but you’re letting them fill in their personal experience. Being able to kinda put that into song and share that with each other is a really powerful thing. ‘Cause then you have everyone else in the group being like I hear you, I see you – oh my gosh – that - me too!

But, you know, there is, you know, group singing/lyric analysis – um, we’re talking about social connection: it could be like a conversational song. There’s a lot of things…

Erica: Yeah. When you were talking about community music therapy, you noted there’s a performative quality to it. I’m curious: what are the possible barriers that occur for participants because of this performative quality?

Sarah: Right. Yeah, I think that’s a really awesome question you posed – and I think it’s a great thing to challenge even these really proven music therapy techniques. But, for people who don’t know, performative does relate to the performance within and outside of the music therapy session. And it’s like a way of forming relationships that promotes health and wellbeing with anyone involved.

And I – I think a huge barrier could 100% be vulnerability. It’s hard to put yourself out there. Um, imagine yourself – first time in treatment – and someone’s saying, okay, put your feelings in a song! It’s like, whoa! Like, are you sure?! Am I in the right place here?

Erica: Yeah.

Sarah: It’s hard to tell your story when maybe, especially in the past, you received that stigma – that poor reaction regarding living with the illness. So, I think vulnerability, in any music therapy session – um, qualities of the practice aside – I think vulnerability is the big barrier for this work um that music therapists have to really learn to break down and make the clients feel comfortable and make them feel safe.

Erica: Mmm, yeah. And a huge thing about feeling safe, that I think is noteworthy, is that it’s not up to the therapist to determine if the environment feels safe—

Sarah: Right—

Erica: That is up to the clients.

Sarah: 100%. You can try and say, okay this is a safe space, but that can easily turn around. Even if it starts off safe, I think it’s really important to be honest in the fact that no – that can change any second based off your clients and, you know, where they’re at in the space. And kind of just being aware of where they’re all at is important for that reason.

Erica: Yeah. I think we kinda touched on this a little bit – we’ve mentioned like shame and guilt a little bit throughout this conversation. How do you see the impacts of shame with the people you’re working with?

Sarah: Yeah, I mean, just by verbal stories they’ll tell me. Um, and even,y ou know, by working at a psych hospital, I got this opportunity to kind of, you know, talk with their parents, or guardians, or spouse spouses – whatever have you – maybe no family – maybe they have a friend who they wrote down on their, you know, consent forms. And um, I – I think – just kinda like that that story I was telling you earlier, they were like, oh, my family thinks, you know – they don’t know where I am. And it’s – it’s just crazy to me to think wow, like, you feel such a way about your illness that you do wanna lie about where you are, like that’s less painful for you than going through the shame and guilt. But the problem is the shame and guilt are still there – you’re just not sharing it with your family. So maybe it takes away the fear, but it doesn’t necessarily take away the shame and guilt.

Which is kind of something I’ve seen. I’ve seen a lot of people who are quote keeping that from their community really struggle with that, even though they feel like maybe they’ve removed the fear aspect, it’s – it’s not really a clear cut solution to dealing with shame and guilt. It’s always going to be there because that’s the reality of the illness. ‘Cause, like I said, society put that in everyone’s brain. [Chuckles

Erica: Totally, yeah. I really appreciate that.

We are coming to the end of our time together, so just a couple of last questions for you. One is: what have you learned in your process that you would want to offer to others?

Sarah: Ooh, that’s a good one. I think a lot of the biological things that I’ve learned is something I wanna offer. Because I can’t tell you how many times I’ve heard, oh, well so-and-so’s choosing that – so-and-so’s choosing that. I think people have this like wrong idea that this is a behavioral disorder. And, in some sense, it started that way, but when you use a substance initially, one – it could be from trauma/anxiety/depression – people are using it to self-medicate. That could be the case, right – it always depends. And I think, people don’t think about how the brain responds after that okay, I just wanna make myself feel better – okay, I’ll use it once I’ll use it once. But how the brain responds, it’s not – that’s not a guarantee that it’d be one time. So, when you use substances, it’s norepinephrine, uh dopamine,  and serotonin – those are the neurotransmitters manipulated – and it’s those neurotransmitters that are huge in reward processing. Therefore, you know, the course of addicted behavior is goinna be impacted, and it’s gonna be dependent on that substance to make those neurons fire.

Erica: Yeah—

Sarah: And um, I think that is something, personally, I want to share with people more. And sometimes I will get more on fire about it, if someone’s like, oh, so-and-so has this subs – like, they’re – they’re using heroin and like, I wish they would just stop – they don’t really care about STOPPING ‘CAUSE THEY’RE NOT – I wanna be like, no! It’s their brain! Like – please – like please let me help you help them – help you understand them a little more and what they might be going through. Um, ‘cause all too quickly, I think people are like, oh, well if you wanna stop, just stop. But it’s not that simple.Every use is rewiring the brain – um, it’s affecting those neurotransmitters, it’s affecting GABA inhibitors, um it’s affecting – your brain is literally getting rewired – the reward center is literally changing each time. …Harder and harder and harder to stop.

Erica: Mmm, yeah. Awesome. And then my last question is: if somebody wanted to connect with you, where can they find you?

Sarah: Yeah. Um, so um email is always a great way to reach me – if you want, I love talking about this stuff, so um I could talk about it all day long. 

Erica: Great. I will put it in the episode notes, yes—

Sarah: Yes. That’s the best way to contact me. I’m in the Boston area too – always up for a coffee and a chat about it.

Erica: Very cool.

Sarah: I think it’s a conversation that really can’t die out in order to make a change. And it needs to be - thoughts, I think, of the community need to be challenged in order to keep this kinda work going, and try to be part of the stigma crushing. [Chuckles]

Erica: [Laughs] I love that, that’s awesome, yeah. Perfect. Awesome, yeah. Thank you, Sarah, so much for being here—

Sarah: Thank you for having me—

Erica: And sharing and chatting. I really appreciate it.

Sarah: Yeah, thank you. It was a good time.

Erica: If you’d like to know more about the Music Project, please visit our website at S as in Sam C as in Cat Music Project dot org (SCMusicProject.org. On our website, you can also find transcripts for every podcast episode. If you want to follow along and receive notifications when new episodes are released, we encourage you to subscribe or connect with us on social media @SCMusicProject.

Thanks again to Sarah for being here today.Thank you, listeners, for listening. And we will talk to you next time.

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